JESS in distal humerus fractures: A narrative review of indications, outcomes, and limitations

Distal humerus fractures are complex injuries that pose significant challenges in management owing to articular involvement, comminution, and soft tissue compromise. While open reduction and internal fixation (ORIF) remains the gold standard treatment, Joshi's External Stabilization System (JESS) has emerged as an alternative, particularly in difficult scenarios, such as open fractures, poor soft tissue conditions, or resource-limited settings. This narrative review explores the indications, techniques, outcomes, and limitations of JESS in managing distal humerus fractures, supplemented by institutional experience, highlighting complications and the need for secondary procedures. JESS offers advantages, such as minimal invasiveness, soft tissue preservation, early mobilization, cost-effectiveness, and versatility. However, limitations include pin site infection, inadequate rotational stability, patient discomfort, and risk of nonunion or delayed union. The authors' institutional experience with two adult patients treated with JESS for complex distal humerus fractures required subsequent surgical intervention due to nonunion, emphasizing the limitations of JESS as a definitive fixation strategy in certain fracture patterns. The ideal role of JESS may be in temporizing fixation in polytrauma, staged protocols for open injuries, or in low-resource settings where ORIF is not feasible. Careful consideration of the fracture configuration, soft tissue status, and patient compliance is essential before selecting JESS as a treatment modality. Further prospective studies comparing JESS with standard fixation techniques are warranted to define its precise role in managing distal humeral fractures.